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Young-Wolff KC, Kendler KS, Prescott CA. Interactive effects of childhood maltreatment and recent stressful life events on alcohol consumption in adulthood. J Stud Alcohol Drugs 2012; 73:559-69. [PMID: 22630794 DOI: 10.15288/jsad.2012.73.559] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Childhood maltreatment is associated with early alcohol use initiation, alcohol-related problem behaviors, and alcohol use disorders in adulthood. Heavy drinking risk among individuals exposed to childhood maltreatment could be partly attributable to stress sensitization, whereby early adversity leads to psychobiological changes that heighten sensitivity to subsequent stressors and increase risk for stress-related drinking. We addressed this issue by examining whether the association between past-year stressful life events and past-year drinking density, a weighted quantity-frequency measure of alcohol consumption, was stronger among adults exposed to childhood maltreatment. METHOD Drinking density, stressful life events, and child maltreatment were assessed using structured clinical interviews in a sample of 4,038 male and female participants ages 20-58 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Stress sensitization was examined using hierarchical multiple regression analyses to test whether stressful events moderated the association between maltreatment and drinking density. Analyses were stratified by sex and whether the impact was different for independent stressful events or dependent stressful events as related to a participant's actions. RESULTS Independent stressful events were associated with heavier drinking density among women exposed to maltreatment. In contrast, drinking density was roughly the same across independent stressful life events exposure among women not exposed to maltreatment. There was little evidence for Maltreatment × Independent Stressor interactions in men or Maltreatment × Dependent Stressor interactions in either gender. CONCLUSIONS Early maltreatment may have direct effects on vulnerability to stress-related drinking among women, particularly in association with stressors that are out of one's control.
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52
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Ullman SE, Najdowski CJ, Adams EB. Women, Alcoholics Anonymous, and Related Mutual Aid Groups: Review and Recommendations for Research. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.718969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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53
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A question of commitment – improving practitioner responses to domestic and sexual violence, problematic substance use and mental ill‐health. ADVANCES IN DUAL DIAGNOSIS 2012. [DOI: 10.1108/17570971211241912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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54
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van Dam D, Vedel E, Ehring T, Emmelkamp PMG. Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: a systematic review. Clin Psychol Rev 2012; 32:202-14. [PMID: 22406920 DOI: 10.1016/j.cpr.2012.01.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 12/21/2011] [Accepted: 01/30/2012] [Indexed: 11/16/2022]
Abstract
This article gives an overview of research into psychological treatments for concurrent posttraumatic stress disorder (PTSD) and substance used disorder (SUD), with a special focus on the effectiveness of treatments addressing both disorders compared to treatments addressing one of the disorders alone. In addition, a distinction is made between trauma-focused versus non-trauma-focused therapies for concurrent PTSD and SUD. The databases Embase, Psychinfo, Medline and Web of science were searched for relevant articles. In total, seventeen studies were identified evaluating ten treatments protocols (six trauma-focused and four non-trauma-focused treatment approaches). In general, the studies showed pre-post reductions for PTSD and/or SUD symptoms. Although most treatments for concurrent PTSD and SUD did not prove to be superior to regular SUD treatments, there are some promising preliminary results suggesting that some patients might benefit from trauma-focused interventions. However, the lack of methodologically sound treatment trials makes it difficult to draw firm conclusions. Methodological limitations are discussed, along with recommendations for future research.
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Affiliation(s)
- Debora van Dam
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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55
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Horton EG, Diaz N, Peluso PR, Mullaney D, Weiner M, McIlveen JW. Relationships Between Trauma, Posttraumatic Stress Disorder Symptoms, Dissociative Symptoms, and Lifetime Heroin Use Among Individuals Who Abuse Substances in Residential Treatment. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2011. [DOI: 10.1002/j.2161-1874.2009.tb00047.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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56
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Fowler DN, Faulkner M. Interventions targeting substance abuse among women survivors of intimate partner abuse: A meta-analysis. J Subst Abuse Treat 2011; 41:386-98. [DOI: 10.1016/j.jsat.2011.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 05/26/2011] [Accepted: 06/06/2011] [Indexed: 11/28/2022]
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Petry NM, Ford JD, Barry D. Contingency management is especially efficacious in engendering long durations of abstinence in patients with sexual abuse histories. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 25:293-300. [PMID: 21443305 DOI: 10.1037/a0022632] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Exposure to sexual victimization is prevalent among persons with substance use disorders (SUDs). Contingency management (CM) treatments utilize concrete and relatively immediate positive reinforcers to retain patients in treatment and reduce substance use, and CM may have particular benefits for patients with histories of sexual victimization. Using data from three randomized trials of CM (N = 393), this study evaluated main and interactive effects of sexual abuse history and treatment condition (standard care versus CM) with respect to during treatment outcomes (retention, proportion of negative urine samples submitted, and longest duration of abstinence) and abstinence at a nine-month follow-up. Compared to patients without sexual abuse histories (N = 316), those with sexual abuse histories (N = 77) submitted a significantly higher proportion of negative samples in treatment. In CM, but not in standard care, patients with sexual abuse histories achieved significantly longer durations of abstinence during treatment than those without sexual abuse histories. Although sexual abuse history was not associated with abstinence at nine-month follow-up evaluations, longest duration of abstinence during treatment was significantly associated with this long-term outcome. Results suggest that SUD patients with sexual abuse histories may accrue particular benefits during CM treatment that are associated with long-term abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
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Affiliation(s)
- Nancy M Petry
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3944, USA.
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58
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Bosquet Enlow M, Kitts RL, Blood E, Bizarro A, Hofmeister M, Wright RJ. Maternal posttraumatic stress symptoms and infant emotional reactivity and emotion regulation. Infant Behav Dev 2011; 34:487-503. [PMID: 21862136 DOI: 10.1016/j.infbeh.2011.07.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 06/24/2011] [Accepted: 07/29/2011] [Indexed: 12/14/2022]
Abstract
The current study examined associations between maternal posttraumatic stress disorder (PTSD) symptoms and infant emotional reactivity and emotion regulation during the first year of life in a primarily low-income, urban, ethnic/racial minority sample of 52 mother-infant dyads. Mothers completed questionnaires assessing their own trauma exposure history and current PTSD and depressive symptoms and their infants' temperament when the infants were 6 months old. Dyads participated in the repeated Still-Face Paradigm (SFP-R) when the infants were 6 months old, and infant affective states were coded for each SFP-R episode. Mothers completed questionnaires assessing infant trauma exposure history and infant current emotional and behavioral symptoms when the infants were 13 months old. Maternal PTSD symptoms predicted infants' emotion regulation at 6 months as assessed by (a) infant ability to recover from distress during the SFP-R and (b) maternal report of infant rate of recovery from distress/arousal in daily life. Maternal PTSD symptoms also predicted maternal report of infant externalizing, internalizing, and dysregulation symptoms at 13 months. Maternal PTSD was not associated with measures of infant emotional reactivity. Neither maternal depressive symptoms nor infant direct exposure to trauma accounted for the associations between maternal PTSD symptoms and infant outcomes. These findings suggest that maternal PTSD is associated with offspring emotion regulation difficulties as early as infancy. Such difficulties may contribute to increased risk of mental health problems among children of mothers with PTSD.
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Norman SB, Myers US, Wilkins KC, Goldsmith AA, Hristova V, Huang Z, McCullough KC, Robinson SK. Review of biological mechanisms and pharmacological treatments of comorbid PTSD and substance use disorder. Neuropharmacology 2011; 62:542-51. [PMID: 21600225 DOI: 10.1016/j.neuropharm.2011.04.032] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/18/2011] [Accepted: 04/23/2011] [Indexed: 10/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol/substance use disorder (A/SUD) are frequently comorbid. Comorbidity is associated with poorer psychological, functional, and treatment outcomes than either disorder alone. This review outlines biological mechanisms that are potentially involved in the development and maintenance of comorbid PTSD and A/SUD including neurotransmitter and hypothalamic-pituitary-adrenal dysregulation, structural differences in the brain, and shared genetic risk factors. The literature regarding pharmacological treatments that have been investigated for comorbid PTSD and A/SUD is also reviewed. Empirical data for each proposed mechanism and pharmacological approach is reviewed with the goal of making recommendations for future research. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.
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Affiliation(s)
- Sonya B Norman
- University of California San Diego School of Medicine, San Diego, CA 92161, USA.
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60
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Moran-Santa Maria MM, McRae-Clark AL, Back SE, DeSantis SM, Baker NL, Spratt EG, Simpson AN, Brady KT. Influence of cocaine dependence and early life stress on pituitary-adrenal axis responses to CRH and the Trier social stressor. Psychoneuroendocrinology 2010; 35:1492-500. [PMID: 20570051 PMCID: PMC2945624 DOI: 10.1016/j.psyneuen.2010.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 04/12/2010] [Accepted: 05/05/2010] [Indexed: 11/19/2022]
Abstract
Long-term changes in the hypothalamic-pituitary-adrenal (HPA) axis as a result of early life stress could be related to the development of substance use disorders during adulthood. In this study, the neuroendocrine, physiologic (HR), and subjective responses to corticotropin releasing hormone (CRH) and the Trier Social Stress Task (TSST) in individuals with cocaine dependence, with (n=21)/without early life stress (n=21), non-dependent individuals with early life stress (n=22), and a control group were examined (n=21). CRH increased cortisol and ACTH levels in all groups. However, a significant effect of early life stress on ACTH was observed indicating that the increase in ACTH was greatest in subjects with a history of childhood stress. Post hoc analysis indicated the early life stress/non-cocaine dependent individuals exhibited significantly higher levels of ACTH as compared to the early life stress/cocaine-dependent group. Despite the elevated ACTH response there was no difference between the groups in the cortisol response to CRH. The TSST produced a significant elevation in ACTH and cortisol all study groups. No significant group differences were observed. The subjective stress and peak heart rate responses to the TSST were greatest in cocaine-dependent subjects without early life stress. In response to CRH, subjective stress and craving were positively correlated in cocaine-dependent subjects regardless of early life stress history, while stress and craving following the TSST were correlated only in cocaine-dependent subjects without a history of early life stress. Findings support previous studies demonstrating that subjects with a history of childhood adversity exhibit elevated ACTH and blunted cortisol levels in response to stress. In contrast, HR and subjective stress in response to the TSST were greatest in cocaine-dependent subjects without a history of early life stress, suggesting that childhood adversity may desensitize autonomic and subjective responding to social stress in adults with cocaine dependence.
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Affiliation(s)
- Megan M Moran-Santa Maria
- Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States.
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61
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Ullman SE, Najdowski CJ. Alcohol-related help-seeking in problem drinking women sexual assault survivors. Subst Use Misuse 2010; 45:341-53. [PMID: 20141451 DOI: 10.3109/10826080903443644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2002-2003 correlates of alcohol-related help-seeking were studied in women sexual assault survivors who were current problem drinkers (N = 526) in a large metropolitan area. Volunteer participants completed several valid and reliable instruments (i.e., the TWEAK, GFM, and MAST), which assessed alcohol use and misuse and related help-seeking. Data were analyzed using logistic regression models. Results suggest that correlates of women survivors' alcohol-related help-seeking vary depending on the specific source. Limitations and implications are noted and recommendations for future research are made. This study was funded by the National Institutes on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Sarah E Ullman
- Department of Criminology, Law, and Justice, University of Illinois at Chicago, Chicago, IL 60607, USA.
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62
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Schiff M, Levit S, Cohen-Moreno R. Childhood sexual abuse, post-traumatic stress disorder, and use of heroin among female clients in Israeli methadone maintenance treatment programs (MMTPS). SOCIAL WORK IN HEALTH CARE 2010; 49:799-813. [PMID: 20938876 DOI: 10.1080/00981381003745103] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study investigated association between post-traumatic stress disorder (PTSD) and a 1-year follow-up heroin use among female clients in methadone clinics in Israel. Participants were 104 Israeli female clients from four methadone clinics (Mean age = 39.09, SD = 8.61) who reported victimization to childhood sexual abuse. We tested traces in urine of these female clients for heroin a year preceding and a year following the assessment of their PTSD. Results show that 54.2% reported symptoms that accedes the DSM-IV criteria for PTSD. We found that among childhood victimized women PTSD is associated with more frequent use of heroin at a 1-year follow-up even after controlling for duration of the stay at the clinic, background, other traumatic experiences and heroin use a year prior the assessment of their PTSD. This study shows the potential long-run negative consequences of childhood sexual abuse. Not only are these sexually abused women trapped into drug dependence and addiction, they cannot break the vicious cycle of continuing the use of illicit drugs even when treated for their addiction. One major practice implication is that treatment for PTSD proven efficacious will be provided in the methadone and other drug treatment services.
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Affiliation(s)
- Miriam Schiff
- School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel.
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63
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McDevitt-Murphy ME, Parra GR, Grilo CM, McGlashan TH, Skodol AE, Shea MT, Yen S, Sanislow CA, Gunderson JG, Markowitz JC. Trajectories of PTSD and Substance Use Disorders in a Longitudinal Study of Personality Disorders. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2009; 1:269-281. [PMID: 26366249 PMCID: PMC4567043 DOI: 10.1037/a0017831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in a sample (N = 668) recruited for personality disorders and followed longitudinally as part of the Collaborative Longitudinal Personality Disorders Study. The study both examined rates of co-occurring disorders at baseline and temporal relationships between PTSD and substance use disorders over 4 years. Subjects with a lifetime history of PTSD at baseline had significantly higher rates of SUDs (both alcohol and drug) than subjects without PTSD. Latent class growth analysis, a relatively novel approach used to analyze trajectories and identify homogeneous subgroups of participant on the basis of probabilities of PTSD and SUD over time, identified 6 classes, which were compared with respect to a set of functioning and personality variables. The most consistent differences were observed between the group that displayed low probabilities of both SUD and PTSD and the group that displayed high probabilities of both.
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Affiliation(s)
| | | | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
| | | | - Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine and the Sunbelt Collaborative
| | - M Tracie Shea
- Veterans' Affairs Medical Center and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | - John G Gunderson
- Department of Psychiatry, Harvard University Medical School and McLean Hospital
| | - John C Markowitz
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute
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64
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Gil-Rivas V, Prause J, Grella CE. Substance use after residential treatment among individuals with co-occurring disorders: the role of anxiety/depressive symptoms and trauma exposure. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2009; 23:303-14. [PMID: 19586147 DOI: 10.1037/a0015355] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population.
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Affiliation(s)
- Virginia Gil-Rivas
- Interdisciplinary Health Psychology, University of North Carolina at Charlotte, Charlotte, NC 28213, USA.
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65
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Sullivan TP, Cavanaugh CE, Ufner MJ, Swan SC, Snow DL. Relationships among Women's Use of Aggression, Their Victimization, and Substance Use Problems: A Test of the Moderating Effects of Race/Ethnicity. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2009; 18:646-666. [PMID: 19966947 PMCID: PMC2788967 DOI: 10.1080/10926770903103263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study examined whether relationships among women's aggression, their victimization, and substance use problems were moderated by race/ethnicity. Four hundred and twelve community women (150 African Americans, 150 Latinas, and 112 Whites) who recently were aggressive against a male partner completed a 2-hour computer-assisted interview. ANOVA and path analysis revealed that (a) for all women, victimization and aggression were strongly related; (b) race/ethnicity moderated the relationships between victimization and alcohol and drug use problems; and (c) no groups evidenced a relationship between alcohol or drug use problems and aggression. Findings suggest that it is essential to develop culturally relevant, gender-specific interventions to reduce both women's aggression and victimization, as well as related negative behaviors such as alcohol and drug use.
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66
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Hofmann SG, Richey JA, Kashdan TB, McKnight PE. Anxiety disorders moderate the association between externalizing problems and substance use disorders: data from the National Comorbidity Survey-Revised. J Anxiety Disord 2009; 23:529-34. [PMID: 19059752 DOI: 10.1016/j.janxdis.2008.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 10/24/2008] [Accepted: 10/24/2008] [Indexed: 11/24/2022]
Abstract
Anxiety disorders and externalizing problems are both associated with substance use disorders. However, the nature of this relationship remains unclear. To examine whether presence of an anxiety disorder changes the association between externalizing problems (conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder) and substance use disorders, we analyzed data from the National Comorbidity Survey-Replication, which is based on a nationally representative sample of 9282 English-speaking adults. Presence of externalizing problems was associated with an increased odds for alcohol abuse (OR: 6.7, CI: 5.6-8.1), alcohol dependence (OR: 7.6, CI: 5.9-9.6), substance abuse (OR: 9.9, CI: 8.1-12.2), and substance dependence (OR: 13.1, CI: 9.6-17.8). Similarly, anxiety disorders were associated with increased odds for substance use disorders. The highest association was found between post-traumatic stress disorder and substance use disorder (OR: 9.2, CI: 5.4-15.5). Individuals who met diagnostic criteria for an anxiety disorder and externalizing problems showed consistently and significantly lower odds for substance use problems than subjects with externalizing problems without a comorbid anxiety disorder. The results suggest that presence of any anxiety disorder reduces the association between externalizing problems and substance use disorders, possibly because the fear of bodily symptoms prevents individuals with externalizing problems from engaging in drug-seeking behaviors.
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Affiliation(s)
- Stefan G Hofmann
- Department of Psychology, Boston University, Boston, MA 02215, USA.
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67
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Weizmann-Henelius G, Putkonen H, Naukkarinen H, Eronen M. Intoxication and violent women. Arch Womens Ment Health 2009; 12:15-25. [PMID: 19037713 DOI: 10.1007/s00737-008-0038-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 11/05/2008] [Indexed: 11/27/2022]
Abstract
Alcohol and drugs have been linked to severe violent offending among women as well as men. The purpose of this study was to make a contribution to the limited knowledge of characteristics related to the state of intoxication in violent female offenders. The putative differences in the characteristics of female offenders and their violent offenses in relation to the state of intoxication at the time of the violent offending were examined. Of a nation-wide sample of 109 female offenders found guilty of homicide and other violent crimes and incarcerated in 1999-2000 in Finland, 60 offenders participated in the study. Of these offenders 49 (81.7%) had been intoxicated at the time the of index offenses. These were compared with 11 (18.3%) non-intoxicated offenders using a structured interview, the Structured Clinical Interview II for DSM-IV (SCID-II) and the Hare Psychopathy Checklist-Revised (PCL-R). The prevalence of substance abuse or dependence (73.3% and 0%), personality disorder (89.6% and 36.4%), particularly antisocial personality disorder (66.7% and 0%), as well as a history of criminality (69.4% and 0%) were significantly higher among the intoxicated women than among the non-intoxicated. The PCL-R scores were also significantly higher among the intoxicated offenders than among non-intoxicated offenders. The victims of the intoxicated women (23.9%) were less often emotionally close to the perpetrator than were the victims of the non-intoxicated women (66.6%). No differences emerged between the groups in experiences of childhood and adulthood abuse or stressful life events prior to the index crime. The findings indicate that intoxicated violent female offenders exhibit more of the characteristics previously found in violent men, than do the non-intoxicated female offenders. Moreover, the non-intoxicated group comprises both psychotic non-responsible and non-psychotic, fairly well-adjusted women, who are educated, working or studying at the time of the offense and has no history of criminality. Substance misuse constitutes an obvious risk factor for violent behavior in women, and therefore the prevention should include substance abuse treatment.
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68
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Vallejo Z, Amaro H. Adaptation of mindfulness-based stress reduction program for addiction relapse prevention. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/08873260902892287] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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69
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Hecksher D, Hesse M. Women and substance use disorders. Mens Sana Monogr 2009; 7:50-62. [PMID: 21836779 PMCID: PMC3151455 DOI: 10.4103/0973-1229.42585] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 08/11/2008] [Accepted: 08/13/2008] [Indexed: 11/04/2022] Open
Abstract
Substance use disorders belong to the class of externalizing behaviours that are generally more common among men than women. Those women who do have substance disorders therefore deviate more from the norms of society compared with men, tend to live in an environment characterized by high risk of violence and other forms of abuse, and tend to be survivors of childhood trauma. In terms of seeking treatment, women often have difficulty acknowledging their problems with substance use disorders, and professionals are reluctant to ask women about drug or alcohol use. Even when they do seek treatment, women in many countries face practical and financial barriers to access treatment. For women who do enter treatment, outcomes are generally comparable to outcomes for men, suggesting that facilitating entry into treatment can yield substantial benefits for women with addictions.
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Affiliation(s)
- Dorte Hecksher
- Aarhus University Centre for Alcohol and Drug Research, Nobelparken bygning 1453, Jens Chr. Skous Vej 3, 8000 Århus C, Denmark
| | - Morten Hesse
- Aarhus University Centre for Alcohol and Drug Research, Nobelparken bygning 1453, Jens Chr. Skous Vej 3, 8000 Århus C, Denmark
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Hyman SM, Sinha R. Stress-related factors in cannabis use and misuse: implications for prevention and treatment. J Subst Abuse Treat 2008; 36:400-13. [PMID: 19004601 DOI: 10.1016/j.jsat.2008.08.005] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 07/24/2008] [Accepted: 08/23/2008] [Indexed: 11/30/2022]
Abstract
We examined the role of stress as a risk factor and motivation for cannabis use/misuse. A systematic review of studies gathered from PsychINFO and MEDLINE databases was conducted. Findings suggest that cannabis is commonly used as a stress-coping strategy. Negative life events, trauma, and maladaptive coping were all related to consumption. Cannabis use for stress-coping purposes was most evident when examining chronic as compared with experimental use. Although many individuals may be able to use cannabis without consequences, there appears to be a subset of individuals who experience greater life stress and who may be more likely to use for stress-coping purposes. These individuals may be at greatest risk for addiction. Chronic use may potentiate stress-related motivation to use/abuse cannabis and is associated with decision-making deficits and alterations in brain-stress pathways that may exacerbate compulsive drug seeking and sensitize individuals to stress-related drug use. Overall, stress-coping interventions and harm reduction focused on reducing the amount ingested may facilitate prevention and recovery efforts.
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Affiliation(s)
- Scott M Hyman
- Department of Psychiatry, Yale University School of Medicine, Substance Abuse Treatment Unit, 1 Long Wharf Drive, Box 18, New Haven, CT 06511, USA.
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71
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Covington SS, Burke C, Keaton S, Norcott C. Evaluation of a Trauma-Informed and Gender-Responsive Intervention for Women in Drug Treatment. J Psychoactive Drugs 2008; Suppl 5:387-98. [DOI: 10.1080/02791072.2008.10400666] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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72
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Engstrom M, El-Bassel N, Go H, Gilbert L. Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship? JOURNAL OF FAMILY VIOLENCE 2008; 23:605-617. [PMID: 34177099 PMCID: PMC8232900 DOI: 10.1007/s10896-008-9183-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Women in substance use treatment report rates of childhood sexual abuse and intimate partner violence that far exceed those reported by women in the general population. Previous research with nonrandom samples of women in substance use treatment suggests that there is a statistically significant relationship between childhood sexual abuse and intimate partner violence; however, little is known about the mechanisms of risk between these two public health concerns among this population of women. To address this gap in knowledge and to inform intervention strategies, this study examined direct and mediated relationships between childhood sexual abuse and intimate partner violence risk among a random sample of 416 women in methadone treatment. In addition to high rates of childhood sexual abuse (57.9%), intimate partner violence (lifetime prevalence, 89.7%; 6-month prevalence, 78.4%), posttraumatic stress disorder (PTSD, 28.6%), and global psychological distress (19.5%), findings suggest that the relationship between childhood sexual abuse and intimate partner violence is mediated by mental health problems and that women experiencing PTSD or global psychological distress are 2.7 and 2.4 times more likely to experience intimate partner violence than women without such experiences, respectively. Although not a mediator in this relationship, financial independence reduced women's risk of partner violence by two-thirds. The paper includes discussion of social learning and stress and coping theories to explicate the findings and to inform intervention strategies.
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Affiliation(s)
- Malitta Engstrom
- School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | | | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
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73
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Weisbart CE, Thompson R, Pelaez-Merrick M, Kim J, Wike T, Briggs E, English DJ, Dubowitz H. Child and adult victimization: sequelae for female caregivers of high-risk children. CHILD MALTREATMENT 2008; 13:235-244. [PMID: 18502979 DOI: 10.1177/1077559508318392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Little is known about the effects of child versus adult victimization or about the effects of victimization on physical health or social support. Mental and physical health outcomes among 890 female caregivers were examined utilizing data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). The study examined whether victimized women (compared to nonvictimized women) would endorse higher rates of depression, lower levels of social support, and poorer recent health. Differences between subgroups of victimized women defined by when victimization occurred (child only, adult only, and both child and adult) were also examined. Women with any victimization and women with victimization during both time periods had the worst outcomes. Child-only victimization effects, however, did not differ significantly from adult-only victimization. This study suggests added vulnerability for women victimized during both childhood and adulthood. Clinicians should carefully assess lifetime experiences of victimization; approaches to such assessment should be refined through further research.
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74
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Arévalo S, Prado G, Amaro H. Spirituality, sense of coherence, and coping responses in women receiving treatment for alcohol and drug addiction. EVALUATION AND PROGRAM PLANNING 2008; 31:113-23. [PMID: 17825910 DOI: 10.1016/j.evalprogplan.2007.05.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 05/25/2007] [Accepted: 05/30/2007] [Indexed: 05/09/2023]
Abstract
PURPOSE To examine the role of spirituality, sense of coherence, and coping responses in relation to stress and trauma symptoms among women in substance abuse treatment. DATA SOURCES/STUDY SETTING Data for the present analyses were obtained from baseline interviews of 393 women in an urban area of Massachusetts. Interviews were conducted from April 2003 to September 2006. Participants came from four substance abuse treatment programs (three residential and one outpatient) participating in the Mother's Hope, Mind and Spirit Study, an evaluation of an intervention funded by the Substance Abuse and Mental Health Services Administration (SAMSHA). PRINCIPAL FINDINGS Stress was significantly associated with drug addiction severity and trauma symptoms were significantly related to alcohol addiction severity. Spirituality, sense of coherence, and coping responses did not mediate the relationship between perceived stress, and posttraumatic stress, and alcohol and drug addiction severity. However, negative and significant associations were found between perceived stress and spirituality, sense of coherence and coping responses, and between posttraumatic stress symptomatology and sense of coherence. CONCLUSION Enhanced substance abuse treatments that increase spirituality, sense of coherence, and coping responses may be beneficial in helping women in substance abuse treatment to manage stress and posttraumatic stress symptoms. However, further research is needed to identify the pathways through which spirituality, sense of coherence and coping responses may mediate the effects of stress and posttraumatic stress symptoms on alcohol and drug addiction severity.
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Affiliation(s)
- Sandra Arévalo
- Institute on Urban Health Research, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Stearns Suite 503, Boston, MA 02115, USA.
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75
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Hyman SM, Paliwal P, Sinha R. Childhood maltreatment, perceived stress, and stress-related coping in recently abstinent cocaine dependent adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2008; 21:233-8. [PMID: 17563143 PMCID: PMC2392892 DOI: 10.1037/0893-164x.21.2.233] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors examined associations between a personal history of childhood maltreatment and the perceived stress and stress-coping styles of recently abstinent and treatment-engaged cocaine dependent adults. Fifty men and 41 women at an inpatient treatment and research facility were administered the short form of the Childhood Trauma Questionnaire (D. P. Bernstein & L. Fink, 1998; D. P. Bernstein et al., 2003), the Perceived Stress Scale (S. Cohen, T. Kamarck, & R. Mermelstein, 1983), and the COPE Questionnaire (C. S. Carver, M. R. Scheier, & J. K. Weintraub, 1989). Simple and multiple linear regression analyses were used to analyze relationships while adjusting for relevant covariates. Findings indicate that overall childhood maltreatment severity was significantly associated with greater perceived stress and greater use of avoidance stress-coping strategies. These findings suggest that having a history of childhood maltreatment may influence how recently abstinent cocaine dependent individuals experience and cope with stress. Stress and stress-coping focused interventions may be particularly indicated for cocaine dependent individuals with histories of childhood maltreatment.
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Affiliation(s)
- Scott M Hyman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA.
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76
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Testa M, Livingston JA, Hoffman JH. Does sexual victimization predict subsequent alcohol consumption? A prospective study among a community sample of women. Addict Behav 2007; 32:2926-39. [PMID: 17597304 PMCID: PMC2045636 DOI: 10.1016/j.addbeh.2007.05.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 04/19/2007] [Accepted: 05/31/2007] [Indexed: 11/15/2022]
Abstract
Although rape and sexual victimization experiences have been hypothesized to contribute to subsequent heavy drinking and alcohol problems among women, little prospective evidence exists. The present prospective study examined whether sexual victimization contributes to subsequent heavy drinking among a community sample of women, 18-30 years of age (n=927). Using three waves of data, 12 months apart, we examined the impact of T1 sexual victimization on T2 heavy drinking, and of T2 sexual victimization on T3 heavy drinking. There were significant bivariate differences between sexually victimized and non-victimized women on heavy drinking both concurrently and prospectively. However, after controlling for prior heavy drinking and demographic variables, most differences disappeared. We also tested the hypothesis that Post-Traumatic Stress Disorder (PTSD) Symptoms would mediate the relationship between T2 sexual victimization and T3 heavy drinking. Although T2 sexual victimization predicted T2 PTSD symptoms, PTSD did not contribute to subsequent heavy drinking. Findings suggest that heavy drinking is relatively stable over time and that sexual victimization does not make a substantial independent contribution to heavy drinking among women in the general population.
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Affiliation(s)
- Maria Testa
- University at Buffalo, Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, USA.
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77
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Clinical challenges in the treatment of patients with posttraumatic stress disorder and substance abuse. Curr Opin Psychiatry 2007; 20:614-8. [PMID: 17921765 DOI: 10.1097/yco.0b013e3282f0ffd9] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review the current literature on co-occuring posttraumatic stress disorder and substance-use disorder, with an emphasis on clinical aspects and emerging treatments. RECENT FINDINGS In clinical populations (focusing on either disorder), about 25-50% have a lifetime dual diagnosis of posttraumatic stress disorder and substance-use disorder. Patients with both disorders have a more severe clinical profile than those with either disorder alone, lower functioning, poorer well being, and worse outcomes across a variety of measures. In recent years, several promising treatment programs have been developed specifically for co-occuring posttraumatic stress disorder and substance-use disorder, with one model having been established as effective thus far. SUMMARY Comorbid posttraumatic stress disorder/substance-use disorder is a frequent diagnosis in clinical populations that severely affects course and outcome. Treatment approaches appropriate for this vulnerable population need to be evaluated further and implemented in routine practice.
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78
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Ford JD, Hawke J, Alessi S, Ledgerwood D, Petry N. Psychological trauma and PTSD symptoms as predictors of substance dependence treatment outcomes. Behav Res Ther 2007; 45:2417-31. [PMID: 17531193 DOI: 10.1016/j.brat.2007.04.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 03/27/2007] [Accepted: 04/10/2007] [Indexed: 11/19/2022]
Abstract
Psychological trauma and post-traumatic stress disorder (PTSD) may complicate and reduce the effectiveness of treatment for substance use disorders (SUDs). This study assessed trauma history and symptoms of simple and complex PTSD at baseline in a randomized trial of contingency management (CM) compared to standard treatment (ST) with 142 cocaine- or heroin-dependent outpatients. History of exposure to each of eight types of psychological trauma was unrelated to treatment outcome, except for witnessed assaults and emotional abuse. Complex PTSD symptoms were inversely associated with short-term treatment outcomes, and PTSD symptoms were positively related to long-term outcome, independent of the effects of demographics, psychological distress, baseline substance use status, and treatment modality. Complex PTSD symptoms warrant further study as a potential negative prognostic factor in SUD interventions.
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Affiliation(s)
- Julian D Ford
- University of Connecticut School of Medicine Psychiatry, MC1410 263 Farmington Avenue, Farmington, CT 06030, USA.
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Zvolensky MJ, Leen-Feldner EW. Anxiety and stress vulnerability and substance problems: Theory, empirical evidence, and directions for future research. Clin Psychol Rev 2005; 25:707-12. [PMID: 15967555 DOI: 10.1016/j.cpr.2005.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This introductory paper briefly reviews each of seven manuscripts in the present special series, the purpose of which was to provide a forum for the systematic presentation of theory, empirical evidence, and directions for future work as it pertains to anxiety and stress-related vulnerability processes and drug and alcohol problems. Articles in the series were selected to highlight a broad range of research on these topics. Whereas past work has largely focused on issues of psychiatric comorbidity, the articles in this series collectively suggest focusing on emotion vulnerability processes and the contexts in which they operate is a particularly valuable and promising pursuit. Each of the contributions also highlights the importance of developing models that explicitly integrate both basic and applied research in order to 1) effectively translate basic research findings to the applied realm, and 2) cast them in a nomological net. Finally, many of the articles noted that there is a pressing need to document theoretically relevant mediating and moderating processes involved with anxiety/stress and drug/alcohol problems in order to meaningfully move towards specialized intervention approaches.
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